Weathering the Storm: How NICE products and services can improve quality and productivity
Keith Dickinson, Associate Director NICE
Outline
• Introduction
• What NICE does
• How NICE can help identify cost savings productivity gains
• Savings and productivity collection
• Summary
Introduction
• Unprecedented challenges
• Quality and efficiency gains required, but reduced funding, and increased demands
• Monitor highlighted potential £30bn funding gap by 2021 - see Closing the NHS funding gap: how to get better value healthcare for patients - October 2013)
• But there is support out there….
The role of NICE
• To identify good clinical, public
health and social care practice using the best available evidence
• To help resolve uncertainty for
the public, service users,
professionals and practitioners• To reduce variation in the availability
and quality of practice and care
Core principles of all NICE guidance
• Comprehensive evidence base• Cost effectiveness reviews included • Expert input• Patient and carer involvement• Independent advisory committees• Genuine consultation• Regular review• Open and transparent process
NICE guidance• Clinical guidelines• Medicines practice guidelines• Public health guidelines• Social care guidelines• Safe staffing guidelines• Interventional procedures guidance• Technology appraisals (medicines)• Medical technologies guidance• Diagnostic guidance• In addition, Quality Standards are produced for
Clinical/Medicines/Public Health/Social Care
Savings and productivity collection
• Costing saving guidance
• Cost saving support
• Public health ROI tool
• Quality and productivity case studies
• Do not do recommendations
• Key therapeutics topics
• http://www.nice.org.uk/About/What-we-do/Into-practice/Commissioning-support
Cost saving guidance
• Implementation of NICE guidance can deliver savings
• Lists where savings can be made
• Forward planning tool
• Quantifiable and non quantifiable savings
Cost saving guidance exam[;esFilter Cost Saving Guidance Published High
Inditherm Mattress for the prevention of inadvertent perioperative hypothermia
Cost saving guidance
August 2011
High
CardioQ-ODM (oesophageal Doppler monitor) to guide intravenous fluid management in patients
undergoing surgery, or in critical care
Cost saving guidance
March 2011 Very High
Constipation (women) - prucalopride
Cost saving guidance
December 2010
Very High
MoorLDI2 Burns Imager a laser Doppler blood flow imager for the assessment of burn wounds
Cost saving guidance
March 2011 High
Hypertension (update)
Cost saving guidance
August 2011
High
Vascular disease - clopidogrel and dipyridamole (review)
Cost saving guidance
December 2010
Very High
Hypertension (partial update of CG18)
Cost saving guidance
June 2006 Very High
Cost saving support
• Aimed at organisations responsible for implementing guidance and standards
• Tools can be used to estimate local costs
• Informs implementation plans and business cases
• Wide range of tools available
Public health ROI tool example
Return on investment toolv1.01 (June 2014)
NICE Return on Investment (ROI) tool for interventions and strategies to increase Physical Activity
Click to Begin
Quality and productivity case studies • Provides practical case studies• Can include case studies wider than NICE guidance• All examples submitted to NICE are evaluated• Evaluation based on meeting the q&p criteria:
1. Savings
2. Quality
3. Evidence
4. Implementation• First 3 criteria are scored, then combined• Overall score used to identify ‘recommended’
NICE Quality and Productivity collection: Avoiding unnecessary referral for glaucoma
Quality and productivity case studies examples
Filter QP Case Study Published Very High
Service redesign: early identification of pati ents at risk of developing end-stage kidney disease
QP Case Study August
2014 Very High
Alcohol Care Teams: to reduce acute hospital admissions and improve quality of care
QP Case Study May 2014 Very High
Peer-reviewed referral management: saving money and increasing quality by improving
referral practice
QP Case Study October
2013 Very High
Stratified cancer pathways: redesigning services for those living with or beyond cancer
QP Case Study October
2013 Very High
Safety Express: a national pilot to deliver harm free care
QP Case Study June 2013 Very High
Management of patients with Stroke: REDS (Reach Early Discharge Scheme)
QP Case Study October
2012 Very High
Prevention of inpatient falls: systematic risk assessment and reduction programme
QP Case Study December
2011 Very High
Service redevelopment: Integrated whole system QP Case Study May 2012 Very High
‘Do not do’ recommendations• Database approach • Contains practices (identified during
guidance development) that should be:– Discontinued– Not used routinely
• Each recommendation contains information on:– Healthcare setting– Links to relevant NICE guidance or Quality
Standard
‘Do not do’ example - View all NICE do not do from this Guidance
• Some ‘do not do’ examples from Pressure Ulcers (CG179):– Do not routinely offer adults, neonates, infants, children and young
people negative pressure wound therapy to treat a pressure ulcer, unless it is necessary to reduce the number of dressing changes (for example, in a wound with a large amount of exudate).
– Do not offer gauze dressings to treat a pressure ulcer in adults, neonates, infants, children and young people.
– Do not use hyperbaric oxygen therapy to treat a pressure ulcer in neonates, infants, children or young people
– Do not routinely offer enzymatic debridement to adults with a pressure ulcer.
Key therapeutic topics
• Not formal NICE guidance
• Summarise evidence-base
• Topics identified to support QIPP medicines use and procurement work-stream
• Example: Wound care products (NICE advice KTT14) published January 2013
Forward Planner
Status Guidance short titleType of guidance
Anticipated publication
date
Programme budgeting category
Impact on PbR
Commissioner(s) Provider(s) Potential cost impact areas (costs or savings)Potential cost impact
In progress
Self-monitoring coagulometers (CoaguChek XS system, INRatio2 PT/INR monitor and ProTime Microcoagulation system)
Diagnostic Technology
Aug-14 10C CCGs and NHS England
Primary care, Community health care, Secondary care - acute and tertiary care
The initial procurement of coagulometers incurs a cost of around £300 per person, while there will also be costs around training people to use them. In the longer-term it may decrease the demand for anti-coag clinics and outpatient services. Additional information will be published when available.
Cost saving
In progress Drug allergyClinical
GuidelineSep-14 20A ? CCGs
Secondary care - acute
Implementing the recommendations may increase the number of referrals to specialist allergy clinics for any given locality. Potential benefits and savings include: reduced hospital admissions; reduced length of inpatient stay from drugs administered during hospital stay; reduced recurrence of allergic reactions and anaphylaxis; and reduced inappropriate referrals to specialist allergy services.
Cost saving
In progress QS_Acute kidney injuryQuality
StandardsOct-14 17B ? CCGs
Primary care and secondary care -
acute
Additional costs are likely to be incurred due to increased rates of serum creatinine and urine testing. However both of these are low cost (typically around 25p and 10p respectively per person) while improved identification of AKI is believed to avoid degeneration and treatment of the consequences of AKI.
Cost saving
Summary• Recognised that the challenge is unprecedented• NICE has a range of products and services that
don’t cost but do save• Includes tools, webinars, models • If you haven’t got at least one ‘NICE product or
service linked to your CIP…. Just type in ‘savings’!• NICE is always looking for individuals and
organisations to contribute to the development of recommendations….